Provider Demographics
NPI:1700979622
Name:OSMOND GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:OSMOND GENERAL HOSPITAL INC
Other - Org Name:WAUSA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIEVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-748-3393
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:OSMOND
Mailing Address - State:NE
Mailing Address - Zip Code:68765-0429
Mailing Address - Country:US
Mailing Address - Phone:402-748-3393
Mailing Address - Fax:402-748-6190
Practice Address - Street 1:100 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAUSA
Practice Address - State:NE
Practice Address - Zip Code:68786-2050
Practice Address - Country:US
Practice Address - Phone:402-586-2244
Practice Address - Fax:402-586-2580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSMOND GENERAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE822554OtherWAUSA (COVENTRY)
NE=========08Medicaid
NE822554OtherWAUSA (COVENTRY)
NE=========004OtherWAUSA (TRICARE)
NE80107305Medicare PIN